EASIER APPROVAL & 6 MONTH DIET INFO
My surgery was approved in 3 days! The bariatric office was in shock but I have a confirmed date. Will share tips I learned along the way:
1. Generally, stop fighting the war. Whatever the insurance companies require just do it. Pick & chose your battles – this is one you will lose.
2. Most carriers, especially BC/BS pay some go-between or medical geeks to review the file for testing results & paperwork. Call the BC/BS and Geeks & find out exactly what is required & in what time frame. Write the entire list down & note who/whom you spoke with, date, time, etc. Get it in writing if possible! Keep a diary – it’ll help your sanity. Find a friend w/a fax you can use for free & a friend that can use a word processor or type if you cannot – you’ll need both later in the process.
3. Schedule an appointment w/your PCP’s office for a complete physical. In the meantime, pick or find a bariatric surgeon’s office & go in ASAP for their orientation program or get their info sheets. Be aware, some surgeon’s require more testing above insurance requirements, which carriers may or may not pay for. Regardless of hassle or costs you MUST meet insurance & doctor’s testing & consult requirements.
4. PCP physical – Most doctor’s require early blood, urine, chest x-ray performed so results are back when you go in for the physicial. Take your list w/you for early testing so as to get everything done at ONE time. If other testing needs to be done, coordinate thru your PCP or get your signed referral(s) before you leave so you can continue on. The PCP office assistance may help you get test dates quicker!
5. Here is what was required by my doctor & carrier so you don’t go into sticker shock: Complete physical, chest x-ray, numerous blood & urine panel including B-Vitamin & Folic acid testing, EKG, stress test, echocardiogram, EGD, upper GI, abdominal ultrasound, ABG/Arterial Blood gasses, PFT/Pulmonary Function Test, Sleep study or consult w/sleep dr., Cardiac consultation, Pulmonary consultation, psychological evaluation, nutritional evaluation, 3 hour glucose tolerance test, PCP support letter or referral, medical clearance for surgery written by my PC, 6 month medical supervised diet w/detailed diet history.
6. “Medically supervised 6 Month Diet History” – The insurance will not accept your Weigh****chers, LA Diet diaries etc. unless his signature & date appears on the diary every month. I came across a form my doctor readily signed & it appears it is exactly what the insurance was looking for. Suggest a separate sheet for each month w/date about the same time each month. Actually, I took 6 completed forms in with me & dr. signed off on them immediately. (The form follows w/notes.)
7. Closing tips: Do your research early to save time, frustration & money. Keep a diary w/notes including who, what, where & why – especially when dealing with the insurance companies as they often lie. Realize while working on approval, the medical profession has NO sense of urgency nor will you be exempt from incompetence, indifference or stupidity. Keep track of tests performed & dates to assure dates fall within required time frames nor do you want to pay for duplicate testing. Make sure testing results go to the bariatric doctor & your PCP – as your PCP needs to know & will often help you deal with the dragons along the way. (It’s called a buy-in) Work hard to have surgery in the same year as testing & paperwork so as not to have to pay double co-pays, deductibles, etc.
Last of all, expect personal meltdown(s) form time to time. The process will drive anyone to the edge of insanity. Have a good cry, kick the dog or take a bubble bath. Contact me for questions or futher suggestions.
Good Luck!
CAW in
Diet History Form sample (Works Great!):
PHYSICIAN PROGRESS NOTE FOR WEIGHT LOSS ATTEMPTS
PATIENT: YOUR NAME HERE
Date:
Weight: 350+ lbs. Unable to obtain due to scale capacity)
Weighed at XXXXXXX on 6/21: 386 lbs.
Type of Diet: What kind? Weight loss using American Diabetes Association Guidelines, American Heart Association, Weigh****chers, Low Fat.
Exercise: Moderate walking daily. (Other possible comments: Problem walking & standing due to arthritis & weight.)
Diet Pills: None. (List kind if pills are used.)
Behavior Modifications Discussed: Continue written food diary. Watch portions.
Additional Comments: (0ptional) Sample of what I used: Patient has continued to schedule testing & consultations for bariatric surgery approval.
Signature_____________________________
XXXXXXXXXXX, M.D.
If you will respond back to me w/your email address I will send you the form in a word document & tips I learned along the way. I promise not to spam you!
I do not own a scanner or Acrobat rights. Let's keep it simple. One page for EACH month on the diet was all it took.
I went thru the entire process of approval. There were pieces of the puzzle on obesityhelp.com but not enough in one place to really give the big pix as to what to expect & what the process takes. It's all here and I can only hope my post keeps bouncing back up from time to time for the new Inquirers to have an idea what they are in for & what is expected for approval.
Frankly, I've come to believe there maybe a conspiracy between insurance & medical profession to make the process more difficult than is necessary to find out if we have the perservance to go thru the approval process as well as dealing with the crap that may come after the surgery. The process of approval is not for the faint of heart - believe me.
You also need to be aware the testing, approval process, surgical fees etc. may not be covered 100% by your insurance company. There probably will be co-pays & deductibles. My insurance pays 80%, which means I will have to come up with the 20% balance.
As a single working class woman, I suspect I will be in bankruptcy or wage earner court next summer because of the medical costs I am going to have to bear. Just more food for thought while you walk this journery.
Regards,
CAW in
Hockeymom87 · 0 replies · 608 views
